The Role of MSC-Derived Exosomes in Immune Modulation and Regenerative Medicine

Mesenchymal stem cells (MSC)-derived exosomes have been identified as highly potential, cell-free therapeutic agents that play pivotal roles in immune-based modulation in conjunction with regenerative medicine. These extracellular vesicles are mostly isolated using ultracentrifugation, size-exclusion chromatography, or immunoaffinity capture and carry a wide range of bioactive molecules (lipids, nucleic acids, and proteins). MSC-derived exosomes have strong immunomodulatory properties, such as inhibition of pro-inflammatory cytokines, expansion of regulatory T cells, and induction of an anti-inflammatory microenvironment. Therapeutically, they are influential in various disease models, some of which include autoimmune disorders, cardiovascular disease, etc. Engineered MSC-derived exosomes present an exciting potential as a drug delivery vehicle in the field of oncology as a means of addressing chemoresistance and improving drug bioavailability. Exosomes have several advantages over MSC-based therapies. Distinct from previous reviews that have examined immunomodulation or regenerative indications in isolation, this article specifically integrates cargo-defined immune rewiring by MSC-derived exosomes with organ-specific regenerative outcomes across inflammatory, autoimmune, oncologic, and neurodegenerative disorders, and links these mechanisms to emerging drug-sensitization strategies and early-phase clinical trials. This narrative review includes the strategies of purifying MSC-derived exosomes and their potential therapeutic importance in diseases, where standardized methods are needed to improve clinical translation.